HomeMy Public PortalAbout9033 JAYLEE DR_Sewer_9/2/1955_sewer connection 76A642D APUCFO■ U PERMIT IT � `.
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County"Engineer
County of LOS Angeles BUILDING
W.M.J. FOX, COUNTY ENGINEER
CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY p
�'J
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTIONLOT NO. OWNER
BLOCK TRACT C �•' MAIL :, __.
ADD ESS - .n J L/
OS
SIZE OF LOT NOW ON LOTTEL.
USE OF
BUILDINGS' _ Y J"� - DISTRICT NO. GROUP MAP
-�. A I I BK PG
' CONTRACTOR �, "� y
ADDRESS �,�,•i/. CONNECTION DATA
STATION C�. _ � DEPTH
0-4:r-ATE - MANHOLE REFERENCE
REGISTRATION NO. e•�' Cl COUNTY 7 �'�' UPPER Lj3SdEFB�
TYPE OF CON ECT.WN-- LENGTH FROM j
NO. DESCRIPTION OF WORK FEE i. Y. CURB ( P.L. M.L.TO P.L. / �)
HOUSE SEWER CONNECTING TO
-.PUBLIC SEWER a $ 3:50
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR - CO. IMP. N0. / ' JOB. N0.
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING
_ SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT N0. /y
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL.-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 �C HARGES
CONNECTION CHARGE FEE
OWNERS PERMIT $ 1 00
AUTHORIZATION TOTAL FEE (_/ REIMBURSEMENT FEES
I HAVE THIS DATE CONTR�AC D WITH_THE.HEREIN NA ED CON-
TRACTOR TO-CONNECT THE AB VE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC-SE ER. - - _
SIGNED THIS DAY F 't9 s HOUSE SEWER . 1-43- ' �4 r /T�« ��C•bL
OWNER OR CONNECT ADDITIONAL
OWNERS A.G I BUILDING OR WORK
SEPTIC TANK, SEEP; PIT(S)
ADDRESS _ AND/OR DRAINFIELD
I HEREBY,ACKNOWLEDGELF AT ! E AD THIS APPLICATION CESSPOOL DRYWELL❑, _
AND STATE THAT THE ABOVE IS CO EC AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES D ATE LAWS REGULATING ALTER, REPAIR,.SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PR ERLY REGISTERED AND/OR SEWAGE
ECT;PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCOABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF T E ABOVE
DESCRIBED RESIDENTIAL PROARTY. BACKFILL SEPTIC TANKS❑
fes- SEEP. PIT(S) ❑ CESSPOOLS
SIGNATURE
OF PERM]TTE� -
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
BY C0 7 e1 9 61-c-1 SEP 4
4.5 Q .
DEPUTY ~DEPUTY
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Y BY
DEPUTY DEPUTY